Answered by

Joey Lim, MEd (ABA), BCaBA
Beanstalk Child Psychology

Erin Leif, PhD, BCBA-D
Association for Science in Autism Treatment

Lim and Leif Clinical Corner

Photo permission granted: Beanstalk Child Psychology

Parents, like yourself, typically have a whole host of questions when first starting an ABA program. What does a therapy session look like? What do I need to do to begin? What does my involvement look like? These are some of the questions that we often get asked by parents when starting a new ABA program. Understandably, coping with changes can be stressful at first, let alone starting something new that is going to impact your daily routine and life. Let’s start at the beginning.

Initial assessment

An initial assessment should be conducted prior to the design of an intervention program. The assessment process can include formal skills assessments, observation of your child in their natural environment, and an interview with parents and caregivers. Assessments are conducted to identify your child’s strengths, preferences, needs, and skill deficits. Some of the common areas that are assessed include social, language, learning, and personal independence skills. This is an excellent time to make sure your concerns are expressed so that they can be included in the initial goal setting process.

The start of therapy sessions

No two children on the spectrum are alike, so this is why your child’s intervention program will be individualized (i.e., made just for them). The results from the initial assessment as well as parents’ priorities and concerns will guide the development of treatment goals and an individualized intervention plan. Typically, an individualized intervention plan describes the specific skills that will be worked on with your child, how data will be collected to monitor your child’s progress, and information that will allow us to determine when your child has mastered the skill.

There has been an abundance of research demonstrating that intensive ABA programs may result in significant improvement across a range of skills, such as language, adaptive, social, and cognitive skills (Cohen et al. 2006; Eikeseth et al., 2007; Howard et al., 2005). Intensity refers to the number of hours of intervention your child will participate in each week. Your BCBA or supervising professional will recommend an intensity of intervention that is commensurate (i.e., matches) with your child’s strengths and needs, treatment goals, and other life factors such as the age of your child and the time your child spends in other activities. Children who have developmental delays in a range of areas will likely benefit from a more intensive therapy program.

Pairing ourselves with preferred activities

Your child’s Early Intensive Behavior Intervention (EIBI) program will always start with pairing sessions, where it’s ALL about what your child loves and having fun with their new therapist! We enrich the environment with lots of toys, and activities like spins, tickles etc., initially for free (without any demands placed)! We want your child to think of their new therapist as the giver of good things! It is important for therapists to build a positive relationship with your child, and for your child to see them as fun and engaging. When your therapist comes into the room, your child should want to be with them. Research shows that pairing may improve cooperation and acquisition of new skills (Kelly et al., 2015) and reduce the frequency of challenging behavior during therapy sessions (Shillingsburg et al., 2014; Shillingsburg et al., 2018).

Data collection

One of the critical components of EIBI is collecting data. Data on skill acquisition programs and challenging behavior will be recorded during sessions by your child’s therapy team, which consists of your BCBA or supervising professional and the therapists who are trained to work with your child. Your therapy team will analyze the data regularly because these data are used to evaluate your child’s progress and guide the program planning. If the data show that your child is progressing and learning new skills, your team will add new skills to the program and ensure learned skills are generalizing across people, settings, and materials. If the data show that the child is making little or very slow progress, your team will evaluate and modify the program to ensure continued progress.

Teaching new skills

Your child’s therapy program will likely consist of a variety of evidence-based teaching strategies (i.e., strategies that are proven to work). Some skills may be taught using more structured teaching strategies like discrete trial teaching, with an emphasis on breaking skills down into small teachable components and providing lots of practice opportunities. Once new component skills are acquired, they are incorporated into larger, more complex skills. Other skills will be taught in the context of everyday activities, such as play time, meals, and community outings, often using natural environment teaching or shaping and chaining. Most teaching strategies involve the use of prompts to help your child successfully perform the skill, fading of prompts as the child becomes more independent, and lots of positive reinforcement along the way.

Even though there is structure, consistency, and practice in EIBI, therapy sessions should be fun and engaging. We don’t teach skills just at the table – they should be taught anywhere and everywhere (the living room, backyard, playground, and kitchen, just to name a few). The first author still remembers running one entire therapy session at the sink with a child, because she decided she wanted to give her Barbie dolls a spa bath that day. It was during play that we practiced conversational skills, turn-taking, and listening comprehension – all in the context of a fun and natural play activity!

Challenging behavior can get worse before it gets better

One very common goal from parents is to reduce challenging behavior. As fun and engaging as we strive to make our sessions, at times we may see an increase in challenging behavior at the start of an ABA program – as we start asking the child to do things. This typically happens because in the past the child might have had free access to all of their favorite things, along with minimal demands. Now, we’re asking them to do something before having a turn with a favorite toy, for example.

Often the number one priority in early ABA therapy sessions is to teach and reinforce cooperation and establish what we call ‘instructional control.’ Robert Schramm and Megan Miller’s The Seven Steps to Earning Instructional Control is one of our favorite reads, and we highly recommend this book to parents. As we gradually start placing demands on your child, we may see a spike in challenging behavior, which may be escape motivated behavior. Hang in there when that happens, parents! Behavior can get worse before it gets better. However, by using reinforcement effectively and introducing instructions slowly and with support from your therapy team, we can minimize the likelihood of seeing an increase in challenging behavior. In addition, your BCBA or supervising professional will track the frequency of challenging behavior, and will monitor the data closely to make sure any increases in challenging behavior are responded to quickly.

Parent Involvement

Parents are an integral part of their child’s therapy team and are encouraged to be involved in therapy sessions. Research has consistently shown that parents’ participation in programs is key to the success of early intervention programs (Mancil et al., 2006; Ozonoff & Cathcart, 1998). Parental involvement is essential for various reasons. Consistency is the key to behavior change, and it is important that parents are able to implement interventions and teaching strategies in everyday life outside of therapy sessions. It is also essential that parents know which skills their child is learning or has mastered so they can encourage them to use those skills outside of therapy sessions. This will contribute to the generalization of skills across people and environments (i.e., places). For example, if your child is learning to request their preferred items, you can be involved in sessions by keeping the preferred item out of reach and giving it to your child only after they have requested. Outside of therapy sessions, you can then continue to expect your child to request before gaining access to his favorite toy, using the mode of communication they are learning in therapy sessions.

Summary

Starting an early intervention program for your child may seem overwhelming, but you have chosen an intervention that is evidence-based. That means there is plenty of research showing that EIBI delivered using the principles and methods of ABA can result in substantial and sustainable functional improvements for children with autism and related conditions. As you move forward with your program, we encourage you to actively participate, ask lots of questions, and openly share your questions and concerns with your team. This will help your team design and deliver a truly personalized therapy program that reflects your family and child’s goals, values, and needs.

References

Cohen, H., Amerine-Dickens, M., & Smith, T. (2006). Early intensive behavioral treatment: Replication of the UCLA model in a community setting. Developmental and Behavioral Pediatrics, 27, 145–155.

Eikeseth, S., Smith, T., Jahr, E., & Eldevik, S. (2007). Outcome for children with autism who began intensive behavioral treatment between ages 4 and 7: A comparison controlled study. Behavior Modification, 31, 264–278.

Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G., & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26, 359–383.

Kelly, A. N., Axe, J. B., Allen, R. F., & Maguire, R. W. (2015). Effects of presession pairing on the challenging behavior and academic responding of children with Autism. Behavioral Interventions, 30, 135-156.

Mancil, G. R., Conroy, M. A., & Nakao, T. (2006). Functional communication training in the natural environment: A pilot investigation with a young child with Autism Spectrum Disorder. Education and Treatment of Children, 29(4), 615-633.

Ozonoff S., & Cathcart, K. (1998). Effectiveness of a home program intervention for young children with autism. Journal of Autism and Developmental Disorders, 28(1), 25-32.

Schramm, R., & Miller, M. (2014). The seven steps to earning instructional control. Pro-ABA.

Shillingsburg, M. A., Bowen, C. N., & Shapiro, S. K. (2014). Increasing social approach and decreasing social avoidance in children with autism spectrum disorder during discrete trial training. Research in Autism Spectrum Disorders, 8, 1443–1453.

Shillingsburg, M. A., Hansen, B., & Wright, M. (2014). Rapport building and instructional fading prior to discrete trial instruction: Moving from child-led play to intensive teaching. Behavior Modification, 43(2), 288-306.

Citation for this article:

Lim, J., & Leif, E. (2020). Clinical Corner: What is involved in an early intensive ABA program for autism?  Science in Autism Treatment, 17(6).

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